Acetaminophen (Children’s Tylenol) How Supplied: Concentration: Dose: 160-480mg PO 118ml btl 160mg per 5ml Anti-Pyretic • Minor Aches & Pains Contra: Contact medical control if patient is on Warfarin or has liver disease • Severe liver damage can occur if patient takes more than 5 doses in 24 hour period • Do not use with other drugs containing acetaminophen Administration Notes: Children’s Tylenol Under 24 lbs Under 2 years Ask a doctor 24 – 35 lbs 2 – 3 years 1 teaspoon or 5 ml 1 ½ teaspoons or 7.5 36 – 47 lbs 4 – 5 years 48 – 59 lbs 6 – 8 years 2 teaspoons or 10 ml 2 ½ teaspoons or 12.5 60 – 71 lbs 9 – 10 years 72 – 95 lbs 3 teaspoons or 15 ml Activated charcoal (Actidose) How Supplied: Concentration: Dose: 1gm/kg PO 25gm/120ml btl 0.2gm per ml Overdose of many Ingested Poisons Ineffective for poisonings or OD of Cyanide, mineral acids & alkalies Administration Notes: Children < 12: 1gm/kg to max of 50gm. 12 and older 50 – 100gm (2 – 4 bottles) Contains sorbitol for laxative properties to aid in elimination of bound toxins. Adenosine (Adenocard): How Supplied: Concentration: Dose: 6mg - Rapid IVP 6mg/2ml PF 3mg per ml 2nd: 12mg - Rapid IVP 12mg/4ml PF May repeat x 1 Supra-Ventricular Tachycardia (SVT) 2° or 3° AV block • VT • Sick Sinus Syndrome Administration Notes: For best results, use most proximal vein such as antecubital; have 10ml saline flush attached to 2nd port & push immediately after or simultaneously with push of adenosine.
Albuterol (Proventil) How Supplied: Concentration: Dose: 2.5mg Nebulized 2.5mg/3ml amp 0.83mg per ml Bronchospasm Tachydysrhythmias • Use with caution in pt’s with Hx of heart disease or hypertension Administration Notes: Place 2.5mg with 3ml of normal saline in nebulizer cup & set o2 to 5-6 liters per minute.
Amiodarone (Cordarone) How Supplied: Concentration: Dose: 150mg - IV over 10min 150mg/3ml PF 50mg per ml 300mg – IVP Pulmonary congestion • Cardiogenic shock • Hypotension Administration Notes: Loading dose for cardiac arrest: 300 mg IVP (2 Prefilled syringes) For unstable VT – 150mg IV over 10 min:
Place 150mg (1 prefilled syringe) in 100ml of normal saline, give over 10 min Set pump to 600ml/hr if using IV pump. If setting manual drip: Using 10gtt IV Set: 150mg in 100ml, you need to give 10ml per minute or 100ml in 10 min. 100gtts per min. or approx: 1.5gtts per second = 100ml in 10 min.
Aspirin (ASA) How Supplied: Concentration: Dose: 324mg PO 81mg per tab Anti-Platelet Aggregation GI Bleeding • Bleeding disorders • Children under 12 with Flu-like symptoms • Peptic ulcer • Liver problems Administration Notes: 4 tablets = 324
Atropine sulfate How Supplied: Concentration: Dose: 0.5 – 1mg IVP 1mg/10ml PF 0.1mg per ml Asystole • PEA • Symptomatic Bradycardia • Organophosphate Poisoning Atrial fibrillation or Atrial flutter with rapid ventricular response (RVR) • Glaucoma • Myocardial Infarction (USE WITH EXTREME CAUTION) Administration Notes: Bradycardia: 0.5 – 1mg IV q 5 min until desired heart rate reached or total of 0.04mg/kg has been given (approx. 3mg in average sized adult; 4 mg in larger adult) Asystole: 1mg IVP q 3-5 min, max 0.04mg/kg; Peds: 0.02mg/kg IV or ET to max of 0.5 mg for children, 1mg in adolescents. Organophosphate poisoning: Your most likely not going to have enough Atropine on board the truck; Rx for OP poisoning is 1 – 3mg IV as a loading dose; Continue administration of Atropine at 1 – 3mg q 30 min until SLUDGE symptoms subside; The dose listed is a minimum & should be titrated to patient response; more or less may be needed; monitor your patient closely. SLUDGE – Salivation – Lacrimation – Urination – Defecation – Gastrointestinal motility - Emesis Calcium chloride How Supplied: Concentration: Dose: 2 – 4mg/kg IVP 1gm/10ml PF 100mg per ml Calcium Channel Blocker Toxicity • Hypocalcemia with Tetany • Hyperkalemia • Hypermagnesemia Use with caution in digitalized patients due to increased ventricular irritability & can precipitate digitalis toxicity • Precipitates with Sodium Bicarbonate Administration Notes: Refer to mg/kg chart for quick reference Calcium Chloride is not a common medication given pre-hospital, contact medical control for use if any questions arise and/or 2nd dose is needed.
Clopidogrel bisulfate (Plavix) How Supplied: Concentration: Dose: 300mg PO 75mg/tab 75mg per tab STEMI Pt’s up to 75 years of Age Receiving ASA & Heparin Active bleeding • Recent Hx (Within 3 months) of cerebrovascular, intracranial or intraspinal event • Suspected aortic dissection • Major surgery or trauma within 14 days • Severe uncontrolled hypertension Administration Notes: 4 – 75mg tablets = 300mg
Diazepam (Valium) How Supplied: Concentration: Dose: 2.5 - 5mg IV 10mg/2ml CJ 5mg per ml Status Epilepticus • Sedative Prior to Cardioversion Pregnancy • Head Injury • Hypotension • In conjunction with other CNS depressants • Acute Narrow Angle Glaucoma • MONITOR PATIENT FOR S/S OF RESPIRTORY DEPRESSION. Administration Notes: Administer in 2.5mg IV Increments titrated to effect. Check & record patient’s VS prior to and after administration. Total dose not to exceed 10mg. For status epilepticus 5 to 10mg IV slow may be needed: MONITOR PATIENT FOR S/S OF RESPIRATORY DEPRESSION. PPV may be needed for ventilatory support.
Diltiazem (Cardizem) How Supplied: Concentration: Dose: 0.25 mg/kg IV over 2 min 25mg/5ml Vial 5mg per ml 2nd: 0.35 mg/kg IV over 2 min Rx: Atrial Fibrillation • Atrial Flutter • PSVT VT • Sick Sinus Syndrome • 2nd or 3rd Degree Heart Block • WPW • Hypotension less than 90 mm/Hg • Acute MI • Pulmonary Congestion Administration Notes: Bolus 0.25mg/kg over 2 min initially. If ineffective after 15 minutes, may repeat bolus @ 0.35mg/kg over 2 minutes. IV drip of 5 – 15mg/hr should follow initial bolus.
Diltiazem 5mg/ml Patient weight in kg Bolus Doses in ml’s 1st dose 0.25mg/kg 2nd dose 0.35mg/kg For maintenance drip of 5 – 15mg/hr: Mix 10mg (2ml) in a 100ml bag of normal saline. Set IV pump at a rate of 100ml/hr which = 10mg/hr Manual drip set up: For 10mg/hr: Using a 10gtt IV set. Mix 10mg (2ml) in a 100ml bag of normal saline. Set drip rate at approx. 17gtts/min or approx. 1gtt/4 seconds
Dextrose (D50) How Supplied: Concentration: Dose: 12.5 – 25gm IV 25gm/50ml PF 0.5gm per ml Peds: 0.5 – 1gm/kg IV Slow Rx: Hypoglycemia Intracranial Hemorrhage • Known Hyperglycemia Administration Notes: Start IV in most accessible proximal vein, i.e. Antecubital. Diphenhydramine (Benadryl) How Supplied: Concentration: Dose: 10 - 50mg Deep IM or IV 50mg/ml CJ 50mg per ml Allergic Reactions • Anaphylactic Shock • Dystonic Reactions resulting from Phenothiazine ingestion (Haldol, Phenergan etc.) Asthma • Ulcer Disease • Enlarged Prostate • Glaucoma Administration Notes: Most cases, Benadryl is given deep IM but can be given IV slowly
Dopamine (Intropin) How Supplied: Concentration: Dose: 5 - 20µg/kg/min IV 400mg/250ml Premix 1600µg per ml Cardiogenic Shock • Hypotension • Bradycardia HYPOVOLEMIC SHOCK • Phenochromocytoma (Tumor that produces epinephrine) • VF • Tachydysrhythmias • Deactivates with Sodium Bicarb Administration Notes: It is not advised to manually set drip of dopamine: PLACE ON IV PUMP. Drip calculator in IV Pump has dopamine pre-programmed. **If IV Pump OOS and manual drip is only option: MONITOR YOUR PATIENT CLOSELY. Use the following chart to calculate gtts/min based on desired dose, pt’s weight in kg, & drip set. (60gtt or 10gtt) Dopamine Drip Chart Next Page Dopamine Drip Chart 400mg/250ml (1600µg/ml) 5µg/kg/min 10µg/kg/min 15µg/kg/min 20µg/kg/min kg lbs gtts/minute gtts/minute gtts/minute gtts/minute 60gtts/ml IV Tubing 10gtts/ml IV Tubing Epinephrine 1:1000 (Adrenalin) How Supplied: Concentration: Dose: 0.3 – 0.5mg SQ 1mg/ml amp 1mg per ml 30mg/30ml Vial 1mg per ml Severe Allergic Reaction • Anaphylactic Shock • Acute Asthma Use with caution in patients with angina, hypertension & hyperthyroidism Administration Notes: Allergy or anaphylaxis: 0.5mg SQ Mild to moderate asthma attacks: 0.3 – 0.5mg SQ Peds: 0.01mg/kg 1:1000 up to max of 0.3mg SQ See administration notes under Epi – 1:10,000 for 1:1000 ETT Dosing and for IV drip set up.
Epinephrine 1:10,000 (Adrenalin) How Supplied: Concentration: Dose: 1mg IVP q 3 – 5 min 1mg/10ml PF 0.1mg per ml ETT: 2 – 2.5mg q 3 – 5 min Peds: 0.01mg/kg IV/IO q 3 - 5min - Max 1mg single dose ETT: 0.1mg/kg (1:1000) Max 2mg single dose Rx: Cardiac Arrest None in cardiac arrest Administration Notes: To administer 1mg q 3 minutes during cardiac arrest, if time permits and/or available personnel on scene to assist. IV drip can be set up to accommodate 1mg q 3 minutes using the following drip set up: Mix 12mg of epinephrine (1:1000) from multi-dose vial in 100ml of Normal Saline. This gives you 0.1mg/ml Therefore 10ml = 1mg. 10ml q 3 min = 1mg q 3 min Set IV pump at 200ml/hr = 1mg q 3 min. If setting manual drip: Spike IV bag with 10gtt set & hang drip at 33gtts/min or 1 gtt q 2 seconds. Drip Chart Next Page Using a drip for administration of Epi during a code ensures adequate dosing at given time intervals & frees up hands from having to stop & administer Epi via prefilled every 3 minutes. BE SURE IF PATIENT HAS A ROSC (RETURN OF SPONTANEOUS CIRCULATION) TO TURN OFF EPI DRIP & DISCONNECT TO PREVENT ACCIDENTAL BOLUS! Pediatric Epinephrine Administration 0.15 0.35 0.7 0.01mg/kg ETT Dose 0.2 0.4 0.7 Milliliters or cc’s of drug to be given Furosemide (Lasix) How Supplied: Concentration: Dose: 0.5 – 1mg/kg IV slow 100mg/10ml PF 10mg per ml Up to 40mg Pulmonary Edema Pregnancy • Hypokalemia Administration Notes: May give up to 2 times daily dose of Lasix in acute pulmonary edema. IV injected slow over 1– 2 minutes. Glucagon How Supplied: Concentration: Dose: 1mg SQ, IM or slow IV 1mg/ml PF 1mg per ml Peds: See notes Reconstitutable Hypoglycemia Known hypersensitivity Administration Notes: 1mg SQ, IM or slow IV should give response within 5 – 10 minutes. Peds: 0.5mg (<20 kg) or 0.003 – 0.1mg/kg not to exceed 1mg SQ, IM or slow IV.
Haloperidol (Haldol) How Supplied: Concentration: Dose: 2 – 5mg IM 5mg/ml Vial 5mg per ml Peds: 0.05 to 0.15mg IM Rx: Acute Psychotic Disorders • Emergency Sedation of Severely Agitated or Delirious Person CNS depression • Coma • Pregnancy • Severe Liver & Cardiac Disease Administration Notes: To be given IM only Haldol is rarely given to pediatrics pre-hospital. Contact medical control.
Heparin (Unfractionated) How Supplied: Concentration: Dose: 60 IU/kg – max 4000 IU IV 5000 IU/ml CJ 5000 IU per ml Patients Undergoing Percutaneous or Surgical Revascularization Severe thrombocytopenia • Active bleeding • Hx Stroke within 3 months • Major Surgery or Trauma within 14 days Administration Notes: 70 or > weight Bolus 2000 2700 IU 3000 IU 3300 IU 3600 IU 3900 IU 4000 IU Ipratropium bromide (DuoNeb) How Supplied: Concentration: Dose: 0.5mg Unit Dose (Nebulized) 0.5mg/3ml amp 0.16mg per ml Bronchospasm • Exacerbation of COPD Hypersensitivity to peanuts, soy lecithin or atropine derivatives • Glaucoma Administration Notes: DuoNeb or Combivent contains 0.5mg Ipratropium bromide & 3mg albuterol sulfate. Ketorolac (Toradol) How Supplied: Concentration: Dose: 15 – 60mg IM or IV 60mg/2ml CJ 30mg per ml Analgesia Allergy to NSAID’s • Active peptic ulcer Administration Notes: < 65 years old – one 60mg dose IM > 65 years old – one 30mg dose IM
< 65 years old – one 30mg dose IV 65 or >, renal impairment or weight < 50kg - one 15mg dose IV
Lidocaine (Xylocaine) How Supplied: Concentration: Dose: 1 – 1.5mg/kg IV or ET 100mg/5ml PF 20mg per ml 2nd: 0.5 – 1.5mg/kg q 3 – 5 min 2gm/500ml Premix 4mg per ml to max of 3mg/kg PVC’s • Prophylactic tx of VF or Recurrence of VF after Cardioversion • VT 2nd or 3rd degree heart block • Sinus bradycardia • Idioventricular rhythm Administration Notes: Bolus: See mg/kg chart for quick reference Lidocaine drip: 1 – 4mg/min IV Pump has drip calculator for Lidocaine To set manual drip: Spike Lidocaine premix with 60gtt Micro Tubing and run according to chart: Drip Rate
µgtts/min 1gtt q 1.5 gtts/sec 1gtt q 4 sec 1gtt q 2 sec 1gtt q sec Magnesium sulfate How Supplied: Concentration: Dose: 1 – 4gm IV 5gm/10ml PF 0.5gm per ml Cardiac Arrest • Torsades De Points • Seizures 2o Eclampsia • Hypomagnesemia Heart block • Myocardial damage Administration Notes: Cardiac Arrest: 1 to 2gm IVP (2 – 4ml) Torsades with a pulse: 1 to 2gm diluted in 100ml D5W over 5 to 30 minutes. Mix 1 – 2gm (2 – 4ml) in a 100ml bag of D5W place on pump @ the following settings for given time you want to infuse it in: Manual Drip Using 10gtt Set 200ml/hr 30 minutes 200ml/hr or 30min 33gtts/min or 1gtt/2sec 400ml/hr 15 minutes 400ml/hr or 15min 66gtts/min or 1gtt/sec 800ml/hr 7.5 minutes 800ml/hr or 7.5min 132gtts/min or 2gtts/sec Seizures 2o Eclampsia: 2 – 4gm IV over 25 minutes Mix 3gm (6ml) in 100ml normal saline: Set pump at 250ml/hr OR: 1gtt/1.5 seconds using a 10gtt set (Manual) Meperidine (Demerol) How Supplied: Concentration: Dose: 50 – 100mg IM or IV 50mg/ml CJ 50mg per ml Moderate to Severe Pain Diarrhea caused by poisoning • Pt’s taking MOI (Monoamine Oxidase Inhibitor) medications • L&D of a premature infant • Abdominal or head Administration Notes: 50 – 100mg IM List of common MOI medications: 10 – 25mg IV Parnate (tranylcypromine) Marplan(isocarboxazid) Pediatric dose: 1-2mg/kg dose IM or IV Zelepar (selegiline) Nardil (phenelzine) Emsam (selegiline) Eldepryl (selegiline) Methylprednisolone (Solu-Medrol) How Supplied: Concentration: Dose: 40 – 125mg IV 125mg/2ml Vial 62.5mg per ml Reconstitutable Anaphylaxis • Bronchodilator for Unresponsive Asthma Use with caution in patients with GI bleeding & diabetes • Pregnancy safety not established Administration Notes: Can be given deep IM Metoprolol (Lopressor) How Supplied: Concentration: Dose: 25mg PO 25mg per tab Beta Blocker Therapy for Acute Coronary Syndrome Heart rate < 50 bpm • Systolic pressure < 100mm/Hg • CHF • S/S of shock
• Heart blocks • Severe active asthma Administration Notes: Monitor for hypotension & decreased heart rate.
Midazolam (Versed) How Supplied: Concentration: Dose: 2.5 – 5mg IV or IM 5mg/ml CJ 5mg per ml Sedation Prior to Cardioversion or RSI • Seizures Acute narrow angle glaucoma • Sensitivity to Benzodiazepines Administration Notes: Titrate dose to achieve desired effect. Contact medical control if more than 5mg is needed to achieve sedation. 5mg can be given IM for seizure episodes when IV has not been established. Morphine sulfate How Supplied: Concentration: Dose: 2 – 5mg IV 10mg/ml CJ 10mg per ml Pulmonary Edema associated with CHF • Chest Pain in association Myocardial Infarction Contra: Hypotension • Respiratory depression • Asthma • COPD • Ingestion of depressant drugs • Head injury • Abdominal pain Administration Notes: Give 2 to 5mg IV titrated to effect. Contact medical control for additional dosage.
Naloxone (Narcan) How Supplied: Concentration: Dose: 2 mg IV 2mg/2ml PF 1mg per ml Peds: 0.01mg/kg may repeat at 0.1mg/kg max of 2mg Known Narcotic Overdose Administration Notes: Rapid administration may precipitate projectile vomiting, dysrhythmias, acute withdrawal syndrome & in rare cases pulmonary edema &/or sudden death. Be aware that the half-life is usually shorter than most narcotics & may require additional doses to prevent further or recurrent respiratory depression. Nitroglycerin (Nitrostat, Tridil) How Supplied: Concentration: Dose: 0.4mg SL 0.4mg tab 0.4mg per tab 5µg/min IV titrated 25mg/250ml Vial 100µg per ml Ischemic Chest Pain Known sensitivity to organic Nitrates • Suspected inferior wall MI with possible right ventricular involvement • Systolic pressure < 90 mm/Hg • Extreme Bradycardia • Uncorrected hypovolemia • In conjunction with medications used for erectile dysfunction within last 48 hours Administration Notes: 0.4 mg q 3 – 5 minutes SL to max of 0.04mg/kg or 3 doses in adults. Larger adults 4 doses. IV nitro should be administered at a starting dose of 5µg/minute via IV PUMP ONLY capable of exact dosing. Titrate response to medication q 3 – 5 minutes in 5µg increments then in 3µg increments as you approach desired effect as well as increased time intervals between dose increments. Monitor your patient closely for hypotension. HYPOTENSION MAY WORSEN MYOCARDIAL ISCHEMIA – Hypotension usually responds well to IV fluids. ESTABLISH SECOND IV LINE PRIOR TO ADMINISTRATION OF IV NITRO. Ondansetron (Zofran) How Supplied: Concentration: Dose: 4mg IV/IO/IM 4mg/2ml Vial 2mg per ml Nausea & Vomiting Hypersensitivity • Children < 2 years of age Administration Notes: Adults: 4mg IV, IO or IM Pediatrics: < 40 kg - 0.1mg/kg IV, IO or IM (See mg/kg chart for quick reference) > 40 kg – 4mg Rocuronium (Zemuron) How Supplied: Concentration: Dose: 1mg/kg IV 100mg/10ml Vial 10mg per ml Paralysis to Facilitate Intubation Known hypersensitivity Administration Notes: Adults & Peds: 1mg/kg IV Defasiculating dose: 0.05 mg/kg Defasiculating dose chart: 0.05mg/kg mg 0.15 0.25 1.25 1.5 1.75 0.05 0.05 0.05 0.05 100 110 120 130 3.25 3.5 3.75 Racemic epinephrine How Supplied: Concentration: Dose: 2.25% Nebulized 11.25mg/0.5ml amp 11.25mg per ½ ml Croup in Pediatric Patient’s Hypersensitivity Administration Notes: Mix 2.25% (0.5ml single unit dose) with 3ml of normal saline & nebulize. Succinylcholine (Anectine) How Supplied: Concentration: Dose: 1mg/kg IV 200mg/10ml Vial 20mg per ml Peds < 2: 2mg/kg IV Paralysis to Facilitate Intubation Acute narrow angle glaucoma • Penetrating eye injuries • Burns & Massive crush injuries > 8 hours old Administration Notes: Review RSI or Medication Assisted Intubation thoroughly. Pediatric dose in children < 2 is 2mg/kg due to faster metabolism. Sodium bicarbonate 8.4% How Supplied: Concentration: Dose: 1mEq/kg IV 50mEq/50ml Vial 1mEq per ml Cardiac Arrest • Hyperkalemia • Tricyclic Anti-Depressant Overdose Metabolic alkalosis Administration Notes: 1ml/kg followed by 0.5ml/kg q 10 min for Cardiac Arrest. 1ml/kg for Hyperkalemia & Tricyclic OD Thiamine (B1) How Supplied: Concentration: Dose: 100mg IM or Slow IV 100mg/ml Vial 100mg per ml Chronic Alcoholism for Thiamine Deficiency Administration Notes: Administer prior to D50 if alcoholism is suspected in hypoglycemic patients. Vasopressin (Pitressin) How Supplied: Concentration: Dose: 40 IU IV 20IU/ml Vial 20IU per ml Alternative to Epinephrine for Asystole & PEA • Given with Epinephrine for VF, Pulseless VT None in cardiac arrest Administration Notes: Give 40 IU (2 vials) IV to replace epinephrine with first or second dose of epinephrine during cardiac arrest. Give 40 IU (2 vials) IV with first dose of epinephrine during cardiac arrest when pt is in VF or Pulseless VT.
Board Certified in Gastroenterology Nick Sharma, M.D. Brian D. Feiock, M.D. Brian E. Longendyke, D.O. Michael Weiss, M.D. Michael W. Bays, D.O. Srinivas Raju, M.D. Ramesh Koka, M.D. Tal Hazan, M.D. Julian Perez, M.D. PEPTIC ULCER DISEASE INTRODUCTION — Peptic ulcer disease (PUD) is a chronic (long lasting) condition that affects
DEET-based insect repellents: Are they safe? Michael Tichon1, B.Sc. and John Issa2 .PhD. Individuals define “safe” differently. Therefore, “safe” is not an appropriate term. A more appropriate question is “what are the hazards and risks of using (or not using) a DEET-based insect repellent”. Hazard is the adverse effect that could occur. Hazard is often determined by exposur